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Guidance for Managers - Making a Referral to Occupational HealthWhat is occupational health?Occupational Health is specialist healthcare that essentially provides the linkbetween work and health – advice on preventing ill health from work, and helpingthose with health conditions and disabilities to get into work, to be sustained inwork, and to return to work at the right time following ill health and injury.Our service at Cordell Health is led by two accredited specialists in occupationalmedicine who have a national reputation, supported by our Business SupportManager and her team, our nursing staff led by our Occupational Health NurseManager, who is an experienced senior specialist occupational health nurse(Occupational Health Advisor), and our physiotherapy and other colleagues. All ourclinical team have specialist qualifications and experience in occupational healthpractice, and our administrative support staff all have several years of experiencein occupational health. We all operate to a strict ethical code of practice thatrecognises our unique role where we conform to standards of practice both as healthprofessionals and as advisers to employers.How can occupational health help me/my employee?Although occupational health advice is paid for by the employer, as it is not availableon the NHS, occupational health professionals are independent and provide impartialadvice to managers and employees about work-related health concerns. The benefitof occupational health comes from assessments that improve the chances of aspeedy resolution to issues of health and work (for example sickness absence) andby helping employers fulfil Health and Safety obligations and their responsibilitiesunder other legislation including the Equality Act 2010.When should I make a referral to occupational health?If you are concerned about the health, performance or behaviour of an employee,or an employee tells you about a work-related health concern, we advise you toconsider referring them for an occupational health assessment.The following are examples where a referral to occupational health is usuallyindicated: You are concerned that job or the working environment is making theindividual unwellTheir performance is affected by a health conditionCG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 1 of 7
You are concerned about their ability to do their work due to a healthconditionYou would like expert advice on what support measures you could considerto help an employee with a health conditionAn employee is absent due to sickness for more than 4 working weeksAn employee has a planned long-term absence (e.g. due to surgery)They have repeated short-term sickness absenceEither the employee or their GP has indicated an absence due to stress relatedill healthEstablishing whether or not the employee is fit to attend a meeting (forexample formal or informal management meetings or performance hearing)Do employees have to agree to a referral?No. Occupational health assessments are voluntary and must involve mutualcollaboration and consent. We are unable to accept referrals where the employeehas not consented to the assessment. However, when an employee declines to takepart in an occupational health assessment, they should be advised that theiremployer has little choice but to base fitness-for-work decisions on the evidencethey have available, without the benefit of our impartial, clinical advice.How do I make the referral?Before referring your employee, please discuss it with them to ensure theyunderstand the purpose of a referral to occupational health, why they are beingreferred and confirm that they agree to being referred. Please provide them withour supplementary document ‘Employee’s Guide – Case Management Referrals’.What should I put in the referral form?The short answer is as much relevant information as possible. The more informationyou can provide about the role itself and the health issues as far as you understandthem, the more detailed and helpful our report can be.Examples of things to include are: What you are seeking as an outcome of the referral Any particular aspects of the work causing the employee a problem Sickness absence records or the date they first went absent if still off work Fit notes (Form Med 3) or the detail of what has been put on them plus anyprevious reports from occupational health or treating clinicians Any observed behaviours relating to their health What adjustments or measures you have already taken to support youremployee at work If there are any disciplinary issues or actions being taken, it is useful toinclude this in the referral in order that the clinician can be prepared toconsider the employee’s responses to questions in the correct context.CG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 2 of 7
Once you are ready to refer your employee, please see ‘Client UserManual – OrchidLive’ for step-by-step instructions on how to referyour employee through our IT system.What happens during an occupational health consultation?The clinician will assess the information provided at the time of the consultation,including any information provided by the manager, in addition to that provided bythe employee. Detailed background information and request for specific advice willhelp the clinician tailor the report to your needs.It is important that the referral gives the clinician as much information as possiblefrom the employer’s point of view to ensure objectivity can be maintained. Pleasebe aware that the employee should view the referral you make and therefore willbe fully aware of the contents of the referral and any concerns raised within it.Will you obtain a GP or specialist report?Not usually. In the majority of cases, the occupational health clinician will be ableto obtain a consistent and detailed history and in these cases, additional informationfrom the employee’s GP or treating specialist will add little value. There can oftenbe delays where the doctors concerned are not timely in their response and arecostly as the GP or specialist may charge for providing a report.Many people are provided with copies of letters sent by a treating specialist to theirGP. Your employee should be asked if they have these letters, and to bring them tothe assessment together with other relevant information on their health.There are however occasions when the clinician will need further clinicalinformation (and the employee has no clinic letters etc) to enable them to fullyunderstand the medical situation (including the diagnosis, treatment and outlook)and healthcare plan so will recommend obtaining a specialist or GP report. In thisinstance, your agreement will be sought as additional costs will be involved.What is in the Management Report?The report deals with functional issues - what the employee can and cannot do rather than specific medical diagnoses, unless specific consent is obtained from theemployee to share this with you as the employer in the report.The following questions will always be covered in our standard report: The employee’s current fitness for workDetails of the underlying health condition, subject to employee consent, inas much as the effect on their ability to undertake their roleThe impact of their health condition on daily activitiesThe treatment planThe outlook plus likely timescalesCG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 3 of 7
Whether the health condition is likely to be work-relatedWhat they can and cannot do at workIf absent, when their expected return to work date isWhat treatment or self-help measures can improve their health fasterWhat changes to the workplace or job may help accommodate their problems,within the scope of what we know of your workplace and role flexibility.Whether or not their condition is likely to meet the disability provisions ofthe Equality Act 2010 (please see separate section)If you have any specific questions not covered in the standard report, there is asection in the referral form where these can be specifically asked.Can the employee tell the OH clinician what to write?No. Please note the employee is within their rights to expect amendments to bemade to any factual inaccuracies such as dates; plus the removal of anything whichmay break medical confidentiality if they have not consented to such informationbeing shared. They are not however permitted to request any changes to the opinionof the occupational health professional, nor their recommendations made in thereport, unless further evidence is provided or the situation has changed.When will I get the report?Please note that to meet the requirements of Data Protection legislation and inkeeping with guidance published by the health professional bodies, a copy of thereport will always be provided to the employee. The employee will be offered theoption of a copy of the report being sent to them at the same time it is sent to theemployer, or alternatively before it is sent to you as the employer.If the employee has chosen to receive a copy at the same time it is sent to you, youwill usually receive your report within 2 working days of the consultation.If the employee wishes to see the report prior to its release to you, the employeewill be asked to comment by two working days if sent to them by email, or fiveworking days if sent by post.What should I know about confidentiality and consent?To meet the requirements of data protection legislation, consent is required forsensitive information, for example that regarding health, to be shared with others.Therefore, information about an employee’s health provided to an occupationalhealth clinician, either from another health professional (e.g. their GP) or by theemployee themselves in the course of an occupational health assessment, cannot beshared with you as the employer without the employee’s informed consent. For allconsultations therefore, the occupational health professional is required to obtaininformed consent from the employee (usually confirmed in writing).CG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 4 of 7
Consent can be withdrawn at any time by the employee, but this is rare in ourexperience, as the employee usually understands the benefit of the managerreceiving the report. In the rare occasions that the employee withdraws consent,we will provide general advice to the manager on how to manage the case withoutbreaching confidentiality. In the majority of cases, the manager would be expectedto manage the case on the information they already have and consider the healthand safety implications of any management action they take if they are unable tobe provided with a report. Wherever possible, we work with the employee to releasea report which is factual and objective in order that the manager has someinformation to assist them in best managing the employee.During the consultation, confidentiality of personal sensitive information is discussedand the amount of detail regarding the medical condition that is included in thereport is agreed. This is usually sufficient for the manager to understand therequirements for any adjustment, but will not be the detail we take for our clinicalnotes. To meet data protection legislation obligations, we are required to considerwhat is sufficient information for the purpose of the report.The Equality Act 2010 and how does that relate to amanagement referral?The Equality Act 2010 brought together all previously existing anti-discriminationlegislation. The disability provisions of the Act essentially “level the playing field”so that those who have an impairment of their physical or mental health may beable to make full use of their abilities (in this case in their employment), but withreasonably practicable adjustments to allow for their impairment or disabilities.As the employer is required to consider the needs of the individual and makereasonable adjustments, it is important for occupational health professionals toadvise the employer when it is likely the disability provisions of the Act might apply.The disability provisions apply automatically for those with HIV, cancer and multiplesclerosis, but for most people with disabilities we may make a recommendation thatthe disability provisions are likely or unlikely to apply, based on our assessment ofthe case. However, in such cases ultimately this is a legal judgement.Occupational health clinicians consider the following when making their judgement: Does the employee have a physical or mental impairment?Does the impairment(s) have substantial (more than minor or trivial) adverseeffects on normal day-to-day activities?Is the impairment considered to be long term?CG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 5 of 7
What should I do after I get the report?We would recommend that you meet with your employee, discuss therecommendations and agree a plan of action, then review progress as indicated.Do I have to do what the report suggests?No. Our advice is given from a medical perspective and it is ultimately up to youtheir employer, to decide what adjustments are reasonable and practicable toimplement. The adjustments may have a minor, moderate or major impact on youroperations, or on the rest of the team. Therefore, you as the manager will need todecide if the adjustments can be accommodated, and if so, for how long. Wherethey are thought to have a significant impact on the business, we would usuallycontact you to discuss them before including them in the report. In all cases, we dostrive to ensure that adjustments are practical and justified in the report.Please note that our advice stems from our clinical experience in this field and isalways impartial and evidence-based. The ultimate aim is to facilitate either asuccessful return to work or to keep your employee performing optimally in theircontractual role.If in doubt, in addition to discussing recommendations on adjustments with theoccupational health clinician that has made these, you may wish to consult withyour HR team for further advice.What if the employee and/or I disagree about the findings within theoccupational health report?If you don’t agree with the report, or the employee doesn’t agree with therecommendations or other aspects of the report, then please don’t hesitate donadmin@cordellhealth.co.uk or 0118 207 6190. This can be discussed with theoccupational health professional who provided the report, or our Medical Director.What if things don’t progress as expected?The occupational health report may state that the employee is expected to improvein a given timescale. These timescales will be given based on up-to-date medicalevidence, but as human beings we are individual and there will inevitably always bethose who don’t proceed as had been expected.In this case we would recommend you request a review consultation with one of ouroccupational health clinicians for an update on their condition.Fitness to attend meetings and work-related stressCG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 6 of 7
Evidence shows that the longer someone is absent from work, the harder it is toreturn. More specifically, in the cases of stress-related ill-health, addressing thesource of that stress is usually key in starting the road to recovery.When that perceived source is the work environment, our default position, andadvice to the employee, is for them to attend meetings at work to address this.Otherwise nothing will change and the barrier to returning to work remains. It isunusual for the employee to be too unwell to attend, and so although they may beimpaired they are likely to be fit to attend and will usually benefit by doing so.CG-DC-02 Manager’s Guide – Case Management ReferralsCordell Health LtdVersion 4Issued: 22 Jan 2018Page 7 of 7
Manager and her team, our nursing staff led by our Occupational Health Nurse Manager, who is an experienced senior specialist occupational health nurse (Occupational Health Advisor), and our physiotherapy and other colleagues. All our clinical team have specialist qualifications and experience in occupational health
